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aspirin and gastrointestinal bleeding

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7521. Early and long-term (one-year) effects of the association of aspirin and oral anticoagulant on thrombi and morbidity after replacement of the mitral valve with the St. Jude medical prosthesis: a clinical and transesophageal echocardiographic study. (Abstract)

, there was a high and comparable incidence of strands in the two groups (group A+: 44%, 58%; group A-: 49%, 63%). However, the incidence of nonobstructive periprosthetic valve thrombi was significantly lower in group A+ at 9 days: 5% versus 13%, p = 0.03. Total thromboembolic events were reduced in group A+ (9% vs. 25%, p = 0.004) although there was an increased incidence of gastrointestinal hemorrhage (7% vs. 0%). Overall mortality was 9% in group A+ and 4% in group A-. Valve-related events were similar (...) in both groups. Early thrombi, but not strands, were associated with higher morbidity, especially thromboembolic events (30% vs. 13%, p = 0.003).One year after MMVR, the association of aspirin with OAC reduced thrombi and thromboembolic events, but not morbidity, due to an increase in hemorrhagic complications.

2000 Journal of the American College of Cardiology Controlled trial quality: uncertain

7522. Gastroduodenal tolerance of 75 mg clopidogrel versus 325 mg aspirin in healthy volunteers. A gastroscopic study. (Abstract)

Gastroduodenal tolerance of 75 mg clopidogrel versus 325 mg aspirin in healthy volunteers. A gastroscopic study. Clopidogrel is a new antiplatelet agent that offers increased protection over aspirin in preventing vascular ischaemic events in patients with symptomatic atherosclerosis. In a large, randomized, international study of clopidogrel and aspirin (n = 19,185 patients) clopidogrel was associated with a lower incidence of gastrointestinal adverse events, including gastrointestinal (...) haemorrhage and hospitalizations because of gastrointestinal haemorrhage. The aim of the study was to determine whether macroscopic differences in the gastric mucosa between aspirin- and clopidogrel-treated subjects could be detected by gastroscopy after short-term treatment.Thirty-six healthy volunteers were randomized in a double-blind, double-dummy, parallel design, to 75 mg/day of clopidogrel or 325 mg/day of aspirin for 8 days. Gastroscopy was performed at base line before administration of study

2000 Scandinavian journal of gastroenterology Controlled trial quality: uncertain

7523. Coagulation, fibrinolytic and platelet function in patients on long-term therapy with aspirin 300 mg or 1,200 mg daily compared with placebo. (Abstract)

of haemostatic and platelet functions in 49 patients with transient ischaemic attacks randomly allocated to aspirin 300 mg a day, aspirin 1,200 mg a day or placebo. All had been taking their allocated treatment for between 9 months and 4 years prior to investigation. Bleeding time was prolonged, serum thromboxane diminished and platelet aggregation to arachidonic acid but not ADP was abolished by both 300 mg and 1,200 mg aspirin, in a non-dose dependent fashion. Serum salicylate increased with the dose (...) aspirin causes greater gastro-intestinal blood loss.

1990 Thrombosis and haemostasis Controlled trial quality: uncertain

7524. Protective effect of enprostil against aspirin-induced gastroduodenal mucosal injury in man. Comparison with cimetidine and sucralfate. (Abstract)

with one of the following regimens: enprostil 35 micrograms twice daily; enprostil 35 micrograms in the morning; cimetidine 200 mg three times daily and 400 mg at night; sucralfate 1 g four times daily; or placebo. In the second week, aspirin (900 mg three times daily) was also administered. Endoscopies were performed before and after the aspirin phase of the study, and lesions (mucosal erosions plus submucosal hemorrhages) were counted in the stomach and duodenal bulb. All treatments were superior (...) to placebo (p less than 0.05). The mean number of lesions in the 70-micrograms enprostil group (8.5) was significantly less than in the 35-micrograms enprostil group, (11.1), the sucralfate group (12.4), or the placebo group (16.0); the benefit over cimetidine (10.1), however, was not statistically significant. The protective effect of enprostil was greatest in the antrum, the site of maximal mucosal injury. Gastrointestinal side effects were reported in all groups, though abdominal pain and dyspepsia

1986 The American journal of medicine Controlled trial quality: uncertain

7525. Therapy of symptomatic pericarditis after myocardial infarction: retrospective and prospective studies of aspirin, indomethacin, prednisone, and spontaneous resolution. (Abstract)

in similar patients. In the retrospective study, 36 episodes of symptomatic PMIP in 34 patients were identified; in the prospective study, 25 episodes of PMIP in 24 patients occurred. Relief from the discomfort of PMIP was noted within 48 hours in almost all patients with either indomethacin or aspirin therapy. Minor gastrointestinal bleeding developed in two patients in the retrospective study and in two patients in the prospective study. In the retrospective study, mild discomfort of PMIP abated within (...) Therapy of symptomatic pericarditis after myocardial infarction: retrospective and prospective studies of aspirin, indomethacin, prednisone, and spontaneous resolution. We studied the efficacy of aspirin and indomethacin therapy in relieving the discomfort of postmyocardial infarction pericarditis (PMIP) in two studies: (1) a retrospective evaluation of patients with symptomatic PMIP during a 5-year period and (2) a prospective, randomized, single-blind comparison of aspirin and indomethacin

1981 American heart journal Controlled trial quality: uncertain

7526. Gastro-duodenal mucosal changes associated with low-dose aspirin therapy: a prospective, endoscopic study. (Abstract)

Gastro-duodenal mucosal changes associated with low-dose aspirin therapy: a prospective, endoscopic study. The association of low-dose aspirin use and gastro-intestinal bleeding is well described. However, the gastroduodenal mucosal changes associated with low-dose aspirin therapy have not been properly evaluated. We undertook a prospective, endoscopic study to evaluate gastro-duodenal mucosal lesions produced by low-dose aspirin.Forty-seven patients with non-hemorrhagic cerebral infarct (...) or transient ischemic attacks and normal upper gastrointestinal endoscopy were randomized to receive either enteric-coated (n=25) or plain (n=22) aspirin (150 mg/day). Follow-up endoscopy was done at 2, 4 and 8 weeks; gastro-duodenal mucosal lesions, if present, were scored. Forty-seven patients with hemorrhagic infarct who were not treated with aspirin served as controls.Twenty eight (60%) of 47 patients receiving aspirin had mucosal lesions; stomach alone was the most frequent site (32%), followed

2002 Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology Controlled trial quality: uncertain

7527. Open access gastroscopy findings are unrelated to the use of aspirin and non-steroidal anti-inflammatory drugs. Full Text available with Trip Pro

in the frequency of ulcer disease when age-matched groups were compared. Although NSAIDs and aspirin are frequently implicated in gastrointestinal bleeding in the elderly, patients referred for investigation of dyspepsia show no increase in major endoscopic pathology. (...) Open access gastroscopy findings are unrelated to the use of aspirin and non-steroidal anti-inflammatory drugs. This study aims to determine whether priority should be given to patients taking non-steroidal anti-inflammatory drugs (NSAIDs) or aspirin when selecting which dyspeptic patients to refer for open access gastroscopy. A total of 8156 patients underwent gastroscopy, all of whom had upper gastrointestinal symptoms. Patients taking NSAIDs or aspirin showed no significant differences

1997 The British Journal of General Practice

7528. Aspirin use and chronic diseases: a cohort study of the elderly. Full Text available with Trip Pro

, and vitamin supplements. In all 61% responded (13,987, 8881 women and 5106 men; median age 73). They formed the cohort that was followed up for 6 1/2 years using discharge summaries from three hospitals serving the area and death certificates from the health department. Only 13 respondents were lost to follow up but seemed not to have died.Incidences of cardiovascular diseases, cancers, gastrointestinal bleeding, ulcers, and cataracts were compared in participants who did and did not take aspirin (...) with those who did not take it, although the increase was significant only in men (relative risks = 6.3, 95% confidence interval 2.2 to 17, for men and 2.1, 0.53 to 8.5, for women). Those who took aspirin daily showed no increased risk of any other cancer, except colon cancer for both sexes combined (relative risk = 1.5, 1.1 to 2.2). The risk of acute myocardial infarction was reduced slightly among regular users of aspirin in men but not women. The risk of ischaemic heart disease was almost doubled

1989 BMJ : British Medical Journal

7529. Effect of preoperative aspirin use in off-pump coronary artery bypass operations. (Abstract)

in the intensive care unit, reexploration for bleeding, and blood product requirements). Secondary outcome measures were stroke, myocardial infarction, gastrointestinal bleeding, and sternal wound infections.There were no differences in patient characteristics between aspirin users and nonaspirin users. The average postoperative blood loss (845 mL versus 775 mL; p = 0.157) and the rate of reexploration for bleeding (3.5% versus 3.5%; p > 0.99) were similar in aspirin users and nonaspirin users. We found (...) Effect of preoperative aspirin use in off-pump coronary artery bypass operations. The effect of preoperative aspirin use until the day of operation on mortality rate and bleeding risks in patients who had on-pump coronary artery bypass operation has been well documented. However, the effect of aspirin use in patients undergoing off-pump coronary artery bypass operation (OPCAB) with regard to postoperative blood loss and morbidity has not been studied. We aimed to determine the effects

2003 Annals of Thoracic Surgery

7530. Specific Treatment Options - gastrointestinal bleeding

-threatening haemorrhage. Gastrointestinal haemorrhage is commonly divided into acute upper and lower GI bleeding: ACUTE UPPER GI BLEEDING Accounting for around 5,000 deaths each year in the UK, upper GI bleeding has a higher prevalence in socioeconomically deprived areas. Constituting 80% of all GI bleeds, they frequently present with a history of aspirin or non-steroidal antiinflammatory drug (NSAID) use. Only 50% of patients present with haematemesis alone, 30% with melaena and 20% with haematemesis (...) . (2002). Non-variceal upper gastrointestinal haemorrhage. Gut. 51(Suppl iv): iv1-iv6. 5 Coppola, M. (2001). Life-threatening upper GI emergencies, part 2: upper GI bleeding and perforation. Journal of critical illness. 16, 8: 367-373. 6 Dallal, H. and Palmer, K. (2001). ABC of the upper gastrointestinal tract: upper gastrointestinal haemorrhage. BMJ. 323: 1115-1117. 7 Derry, S. and Loke, Y . (2000). Risk of gastrointestinal haemorrhage with long term use of aspirin: mata- analysis. BMJ. 321: 1183

2007 Joint Royal Colleges Ambulance Liaison Committee

7531. 82 year old patient on prophylactic aspirin (75mg) daily for IHD. Needs to start NSAID for pain. 1) Do I stop the aspirin whilst she is on the NSAID? 2) Does the NSAID do the same job of aspirin

for developing heart disease.” “ The combination of a NSAID and low-dose aspirin may increase the risk of gastro-intestinal side-effects; this combination should only be used if absolutely necessary and the patient monitored closely.” [3] A study by de Abajo and Garcia Rodriquez examining the risk of upper gastrointestinal bleeding and perforation associated with low-dose aspirin in plain and enteric formulations reported: “The concomitant use of aspirin together with other non-aspirin NSAIDs at high dose (...) on concomitant aspirin and NSAIDs and provide recommendations on gastrointestinal adverse effects: “ What general measures can I take to reduce the risk of GI adverse events in someone taking low dose aspirin? - Reduce the dose of aspirin to 75 mg each day if on a higher dose, as there is no evidence that higher doses of aspirin are more effective than lower doses for prevention of cardiovascular events. - Check that aspirin is not being used where contraindicated (e.g. people with haemophilia and other

2006 TRIP Answers

7532. Aspirin plus esomeprazole reduced recurrent ulcer bleeding more than clopidogrel in high risk patients Full Text available with Trip Pro

: clopidogrel, 75 mg, plus placebo (n = 161) or aspirin, 80 mg, plus esomeprazole, 20 mg (n = 159) twice daily for 12 months. Outcomes: recurrent ulcer bleeding. Secondary outcomes were lower gastrointestinal bleeding and adverse effects. Patient follow-up: 99% (intention to treat analysis). MAIN RESULTS More patients in the clopidogrel group than in the aspirin-plus-esomeprazole group had recurrent ulcer bleeding (table). The groups did not differ for lower gastrointestinal bleeding (table). Adverse event (...) Rodríguez LA, Ruigómez A. Secondary prevention of upper gastrointestinal bleeding associated with maintenance acid-suppressing treatment in patients with peptic ulcer bleed. Epidemiology 1999 ; 10 : 228 –32. Footnotes * See glossary. † Information provided by author. For correspondence: Dr F K Chan, Chinese University of Hong Kong, Shatin, Hong Kong, China. fklchancuhk.edu.hk Source of funding: no external funding. Request Permissions If you wish to reuse any or all of this article please use the link

2006 Evidence-Based Medicine

7533. ISIS-2: Aspirin ± streptokinase in acute MI

? Bottom Line Among patients with acute MI, aspirin and streptokinase reduced 5-week vascular mortality by 20% and 23%, respectively, when compared to placebo. The combination of aspirin and streptokinase reduced the same outcome by 40%. Major Points During the 1960s and 1970s several small trials of fibrinolytic therapy involving mainly IV streptokinase were performed. Meta-analysis suggested that fibrinolytic therapy for acute MI could reduce vascular mortality by 25%. The large trial (1986 (...) Exclusion Criteria History of stroke History of GI bleed or PUD Recent arterial puncture Recent severe trauma Severe persistent hypertension Allergy to streptokinase or aspirin Interventions Randomized by 2x2 factorial design Streptokinase (1.5 million units of Streptase) vs. placebo (hepatitis-B-antigen-free albumin); infused over 1 hour Aspirin (162.5 mg enteric-coated tablets) vs. placebo (enteric-coated starch tablets); given daily for 1 month, with first tablet crushed, sucked, or chewed for rapid

1988 Wiki Journal Club

7534. CAPRIE: Clopidogrel vs. aspirin in CV disease

events by 9% compared to aspirin without an adverse effect on bleeding events. Guidelines 2014 AHA/ASA Secondary Stroke Prevention Guidelines For patients with noncardioembolic ischemic stroke or TIA, the use of antiplatelet agents rather than oral anticoagulation is recommended to reduce the risk of recurrent stroke and other cardiovascular events (Class I; Level of Evidence A). Aspirin (50–325 mg/d) monotherapy (Class I; Level of Evidence A) or the combination of aspirin 25 mg and extended-release (...) and continued for 2 to 3 years, increases the risk of hemorrhage relative to either agent alone and is not recommended for routine long-term secondary prevention after ischemic stroke or TIA (Class III; Level of Evidence A). For patients who have an ischemic stroke or TIA while taking aspirin, there is no evidence that increasing the dose of aspirin provides additional benefit. Although alternative antiplatelet agents are often considered, no single agent or combination has been adequately studied

1996 Wiki Journal Club

7535. IST: Aspirin in acute ischemic stroke

stroke) High risk of adverse effects (eg, hypersensitivity to aspirin, active peptic ulceration or recent GI bleeding, or already on long-term oral anticoagulants) Baseline Characteristics Median time to randomization: 19 hours Within 3h: 4% Within 6h: 16% Within 12h: 37% Within 24h: 66% Age: <50 years: 5% 50-59 years: 11% 60-69 years: 23% 70-79 years: 35% >80 years: 26% Male: 54% Atrial fibrillation: 16% Systolic BP (mmHg): <140: 18% 140-59: 28% 160-79: 26% >180: 28% Stroke syndrome: Total anterior (...) demonstrated a 14% reduction in all-cause mortality at 4 weeks. Together, IST and CAST demonstrated that aspirin led to a reduction of 11 nonfatal strokes or deaths per 1,000 patients in the first few weeks among patients with acute ischemic stroke with a NNT of 91. Guidelines 2014 AHA/ASA Secondary Stroke Prevention Guidelines For patients with noncardioembolic ischemic stroke or TIA, the use of antiplatelet agents rather than oral anticoagulation is recommended to reduce the risk of recurrent stroke

1997 Wiki Journal Club

7536. Influence of omeprazole on the antiplatelet action of clopidogrel associated with aspirin: the randomized, double-blind OCLA (Omeprazole CLopidogrel Aspirin) study. Full Text available with Trip Pro

therapy is widely prescribed worldwide, with PPIs frequently associated to prevent gastrointestinal bleeding. The clinical impact of these results remains uncertain but merits further investigation. (...) Influence of omeprazole on the antiplatelet action of clopidogrel associated with aspirin: the randomized, double-blind OCLA (Omeprazole CLopidogrel Aspirin) study. This trial sought to assess the influence of omeprazole on clopidogrel efficacy.Clopidogrel has proved its benefit in the treatment of atherothrombotic diseases. In a previous observational study, we found clopidogrel activity on platelets, tested by vasodilator-stimulated phosphoprotein (VASP) phosphorylation, to be diminished

2008 Journal of the American College of Cardiology Controlled trial quality: predicted high

7537. Long-term use of aspirin and nonsteroidal anti-inflammatory drugs and risk of colorectal cancer. Full Text available with Trip Pro

-0.95) for more than 14 aspirin per week (P<.001 for trend). Notably, women who used more than 14 aspirin per week for longer than 10 years in the past had a multivariate RR for cancer of 0.47 (95% CI, 0.31-0.71). A similar dose-response relationship was found for nonaspirin NSAIDs (P = .007 for trend). The incidence of reported major gastrointestinal bleeding events per 1000 person-years also appeared to be dose-related: 0.77 among women who denied any aspirin use; 1.07 for 0.5 to 1.5 standard (...) -term use of aspirin doses substantially higher than those recommended for prevention of cardiovascular disease, but the dose-related risk of gastrointestinal bleeding must also be considered.

2005 JAMA

7538. Blood Loss and Complications of Internal Fixation of Femoral Neck Fractures in Patients Treated With Clopidogrel

and internaql fixation has been shown to reduce complication and improve outcome in such patients. Delay of surgery produces less optimal results and is associated with higher morbidity even after 24-48 hours of fracture event. Patients treated with platelet antiaggregants are exposed to higher blood loss during surgery and related complications, as demonstrated in patients treated with Aspirin. However, cessation of antiaggregant therapy before surgery may be associated with complications (...) Accepts Healthy Volunteers: No Criteria Inclusion Criteria: age > 60 pertrochanteric or femoral neck fracture within 48 hours clopidogrel treatment - study group no antiaggregant treatment - control group ASA score <=3 Exclusion Criteria: hematologic malignancy hematologic malfunction warfarin treatment previous active GI or other internal bleeding - within 1 year thrombocytopenia < 150 Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you

2008 Clinical Trials

7539. Oral Misoprostol Versus Intravenous Oxytocin in Preventing Blood Loss After Non-Scheduled Cesarean Section

risk of PPH undergoing non-scheduled Cesarean section. We therefore compared the intra- and postoperative blood loss, as well as drug related side effects in patients, treated by the same surgical and anesthesiological team in one institution. Condition or disease Intervention/treatment Phase Postpartum Hemorrhage Drug: misoprostol Phase 2 Detailed Description: Postpartum hemorrhage (PPH) is still among the leading causes of maternal morbidity and mortality. The incidence of PPH is reduced (...) Go to Primary Outcome Measures : Reduction of postpartum hemorrhage Secondary Outcome Measures : Blood loss medicamentous side effects efficacy of medicaments Eligibility Criteria Go to Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts

2005 Clinical Trials

7540. Hidden blood loss after surgery for hip fracture. Full Text available with Trip Pro

) to 1473 ml (intramedullary hip nail and screw) and was significantly associated with medical complications and increased hospital stay. The type of surgery, treatment with aspirin, intra-operative hypotension and gastro-intestinal bleeding or ulceration were all independent predictors of blood loss. We conclude that total blood loss after surgery for hip fracture is much greater than that observed intra-operatively. Frequent post-operative measurements of haemoglobin are necessary to avoid anaemia. (...) Hidden blood loss after surgery for hip fracture. Our aim was to determine the total blood loss associated with surgery for fracture of the hip and to identify risk factors for increased blood loss. We prospectively studied 546 patients with hip fracture. The total blood loss was calculated on the basis of the haemoglobin difference, the number of transfusions and the estimated blood volume. The hidden blood loss, in excess of that observed during surgery, varied from 547 ml (screws/ pins

2006 The Journal of Bone and Joint Surgery British Volume

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